Barrier device for ostium of left atrial appendage

ABSTRACT

A membrane applied to the ostium of an atrial appendage for blocking blood from entering the atrial appendage which can form blood clots therein is disclosed. The membrane also prevents blood clots in the atrial appendage from escaping therefrom and entering the blood stream which can result in a blocked blood vessel, leading to strokes and heart attacks. The membranes are percutaneously installed in patients experiencing atrial fibrillations and other heart conditions where thrombosis may form in the atrial appendages. A variety of means for securing the membranes in place are disclosed. The membranes may be held in place over the ostium of the atrial appendage or fill the inside of the atrial appendage. The means for holding the membranes in place over the ostium of the atrial appendages include prongs, stents, anchors with tethers or springs, disks with tethers or springs, umbrellas, spiral springs filling the atrial appendages, and adhesives. After the membrane is in place a filler substance may be added inside the atrial appendage to reduce the volume, help seal the membrane against the ostium or clot the blood in the atrial appendage. The membranes may have anticoagulants to help prevent thrombosis. The membranes be porous such that endothelial cells cover the membrane presenting a living membrane wall to prevent thrombosis. The membranes may have means to center the membranes over the ostium. Sensors may be attached to the membrane to provide information about the patient.

BACKGROUND OF THE INVENTION

[0001] 1. Field of the Invention

[0002] The invention relates to a membrane or plug structure applied tothe ostium of an atrial appendage for preventing blood flow and physicalconnection between an atrium of the heart and the associated atrialappendage or appendages to isolate an atrial appendage and preventthrombus leaving therefrom.

[0003] 2. Description of the Related Art

[0004] There are a number of heart diseases (e.g. coronary arterydisease, mitral valve disease) that have various adverse effects on theheart. An adverse effect of certain cardiac diseases, such as mitralvalve disease, is atrial (or auricular) fibrillation. Atrialfibrillation may result in pooling of blood in the left atrialappendage. Blood pooling may also be spontaneous. When blood pools inthe atrial appendage, blood clots can form and accumulate therein, buildupon themselves, and propagate out from the atrial appendage into theatrium. These blood clots can then enter the systemic or pulmonarycirculations and cause serious problems if they migrate from the atrialappendage and become free in blood stream and embolize distally into thearterial system. Similar problems also occur when a blood clot extendingfrom an atrial appendage into an atrium breaks off and enters the bloodsupply. Since blood from the left atrium and ventricle supply the heartand brain, blood clots from the atrial appendages can obstruct bloodflow therein causing heart attacks, strokes or other organ ischemia. Itis therefore necessary to find a means of preventing blood clots fromforming in the atrial appendages and to prevent these blood clots, onceformed, from leaving the atrial appendages to the heart, lungs, brain orother circulations of the patient which can cause heart attacks orstrokes or other organ ischemia.

[0005] U.S. Pat. No. 5,865,791 relates to the reduction of regions ofblood stasis and ultimately thrombus formation in such regions,particularly in the atrial appendages of patients with atrialfibrillation. More specifically, the invention relates to procedures anddevices for affixing the atrial appendages in an orientation thatprevents subsequent formation of thrombus. The invention removes theappendage from the atrium by pulling on it and putting a loop around itto form a sack of the atrial appendage and then cut off from the rest ofthe heart.

[0006] U.S. Pat. No. 5,306,234 relates to a method for surgicallyclosing the passage between the atrium and the atrial appendage orsevering the atrial appendage.

[0007] Other methods of treatment include surgically removing the atrialappendages to prevent blood stasis in the atrial appendages.

SUMMARY OF THE INVENTION

[0008] The invention provides a membrane or plug structure forpreventing blood from entering the atrial appendages to form blood clotsand prevents blood clots formed in the atrial appendages from exitingtherefrom which may cause heart attacks strokes and other embolicevents. The membrane covers the ostium of the atrial appendage andeffectively isolates it from the atrium. It may be larger than theostium of the appendage, and extend over an area larger than theappendage ostium It is percutaneously delivered to the ostium of theatrial appendage by a catheter and then expanded to cover the ostium andhas a means to attach the membrane over the ostium. The membrane itselfis may be porous or non-porous. In the case of a porous membrane, it canbecome infiltrated with cells so that it becomes a “living” structure,and can develop an endothelial/endocardial lining to enable it in turnto become a non-thrombogenic surface. There are may means for fixing themembrane to cover the ostium of the atrial membrane. The membrane'sattachment devices have a means for self-entering the membrane over theappendage ostium. The membrane may be glued on, or have a stents orprongs which pass through the ostium and extend into or through theatrial appendage. Alternatively an anchor in the wall of the atrialappendage may be tethered to the membrane for holding the membrane inplace. Springs may also extend between the anchor and the membrane tohold the membrane against the ostium. The membrane may also be connectedto a tether, elastic tether or spring and a placed through the atrialappendage wall for holding the membrane against the ostium and may pullon the atrial appendage such that its volume is reduced or eliminated,trapping and isolating blood clots therein. Thrombin, activatedfibrinogen, or other biologic filler may be placed in the appendageafter it has been sealed, with the express purpose of clotting the bloodin the appendage, yet preventing clot from escaping the appendage.

[0009] Part of the device may involve a suction apparatus to removeclots that are already in place. The membrane placement may requireclosure of an atrial septal defect created by the placement of thisappendage occluder device.

[0010] Alternatively the membrane may be held in place by a coiledspring filling the volume of the atrial appendage. The membrane may alsofill the atrial appendage itself preventing blood from entering or bloodclots from leaving.

[0011] The membrane itself may be porous or non-porous. In the case of aporous membrane, it can become infiltrated with cells so that it becomesa “living” structure, and can develop an endothelial/endocardial liningto enable it in turn to become a non-thrombogenic surface. It thus candevelop an endothelium and with time becomes highly biocompatible. Itmay be heparin coated to prevent thrombus from forming on the membranesurface, immediately after placement and until it infiltrates with cellsand/or develops an endothelial covering.

[0012] The device, when implanted in the atrial appendage, may also havethe ability to perform electrical monitoring of the heart. This wouldconsist of two or more electrical contacts placed apart on the device,and connected to signal conditioning circuitry for determination ofcardiac features such as rhythm of the atria or ventricles. Anothersensor on the device could measure pressure of the atria, atrialappendage, or ventricular end diastolic pressures (left or right)through the open mitral or tricuspid valves. A suitable telemetry systemwould be used to telemeter this important electrical and hemodynamicinformation non-invasively outside the patient. Also, memory could bepresent on the device in order to record the information for laterrecovery via noninvasive telemetry.

[0013] This device can also be used to close fistulae or connectionselsewhere in the body, such as in the colon or bronchopulmonary systems.Another application of the device would be to seal and strengthen falseaneurysms of the left ventricle by holding the membrane against thefalse aneurysm. The same principles apply, whereby the membrane is heldagainst the fistulae or false aneurysm, held in place by the spring orprong mechanisms.

[0014] The device can also be used to chemically ablate the myocardialtissue of the atrial appendage in order to help limit or eliminate theelectrical propagation of atrial fibrillation.

OBJECTS OF THE INVENTION

[0015] It is an object of the invention to reduce the volume of anatrial appendage to reduce the size of the region for potential bloodstasis formation, and consequently the effective volume of the affectedatrium.

[0016] It is an object of the invention to measure hemodynamics pressure(or flow), or electrical signals in the heart and telemeter them outsidethe body for diagnosis or monitoring.

[0017] It is an object of the invention to be able to close fistulae orconnections elsewhere in the body, such as in the colon orbronchopulmonary systems.

[0018] It is another object of the invention for the membrane to beplaced in a false aneurysm to strengthen this defect and to avoidsurgery.

[0019] It is an object of the invention to reduce the region of staticblood in the atrial appendages and hence the thrombogenicity of theatrium.

[0020] It is an object of the invention to prevent blood clots fromforming in the atrial appendages.

[0021] It is an object o the invention to replace the ostium of theatrial appendage with a non-thrombogenic, biocompatible surface thatprevents blood clots from forming.

[0022] It is an object of the invention to provide a porous membranesurface which becomes lined with endothelial or endocardial cells.

[0023] It is an object of the invention,to isolate the atrial appendagefrom the atrium proper and prevent communication through which thrombuscould migrate.

[0024] It is an object of the invention to minimally invasively preventblood clots from forming in the atrial appendages and escapingtherefrom.

[0025] It is an object of the invention to provide a filter between theatrium and atrial appendage to prevent blood clots from flowingtherebetween.

[0026] It is an object of the invention to fill the atrial appendagewith a material to prevent blood clots from leaving the atrialappendage.

[0027] It is an object of the invention to remove thrombi from theatrium via suction or other means.

[0028] It is an object of the invention to provide a means for securinga membrane over the ostium of the atrial appendage that is colonizedwith cells and provide a highly biocompatible surface including but notlimited to endothelialization.

[0029] It is an object of the invention to prevent thrombus by use ofheparin or other anti-thrombogenic substance on or eluted from themembrane.

[0030] It is an object of the invention to seal the membrane with asubstance injected into the atrial appendage.

[0031] It is an object of the invention to clot the blood inside of theatrial appendage after the membrane is in place with a substanceinjected into the atrial appendage.

[0032] It is an object of the invention to inject a substance into thesealed appendage to ablate the myocardial cells of the appendage, inorder to limit the propagation of atrial fibrillation.

[0033] It is an object of the invention to ensure the membrane iscentered over the ostium of the atrial appendage.

[0034] It is an object of the invention to accurately place the membraneover the ostium of the atrial appendage.

[0035] Other objects, advantages and novel features of the presentinvention will become apparent from the following detailed descriptionof the invention when considered in conjunction with the accompanyingdrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

[0036]FIG. 1 is a partial cross sectional view of a heart showing acatheter entering the left atrial appendage using a retrograde procedurefrom the aorta.

[0037]FIG. 2 is a partial cross sectional view of a heart showing acatheter entering the left atrial appendage using a transeptal procedurefrom the femoral vein or superior vena cava.

[0038]FIG. 3 is a partial cross sectional view of a heart showing acatheter entering the right atrial appendage from the jugular vein oroptionally from the femoral vein.

[0039]FIG. 4 is a partial cross sectional view of a portion of a heartshowing an atrium and its associated atrial appendage.

[0040]FIG. 5 is a partial cross sectional view of a portion of a heartshowing an atrium and its associated atrial appendage with a porousmembrane having flexible wire prongs with atraumatic bulbs to hold themembrane in place and electronics built into the membrane.

[0041]FIG. 6 is similar to FIG. 5 with the atraumatic bulbs removed sothat the flexible wire prongs may puncture the atrium wall and securethe membrane to the atrial appendage and a centering rim added to themembrane.

[0042]FIG. 7 is a partial cross sectional view, of a portion of a heartas in FIG. 5 with a stent portion between the membrane and the prongs.

[0043]FIG. 8 is the same as FIG. 7 with the atraumatic bulbs removed sothat the flexible wire prongs may puncture the atrium wall and securethe membrane to the atrial appendage.

[0044]FIG. 9 is a partial cross sectional view of a portion of a heartshowing an atrium and its associated atrial appendage with a porousmembrane having a large expandable stent to hold the membrane in place.

[0045]FIG. 10 is a partial cross sectional view of a portion of a heartshowing an atrium and its associated atrial appendage having an anchorand a tether to hold the membrane in place.

[0046]FIG. 11 is a partial cross sectional view of a portion of a heartshowing an atrium and its associated atrial appendage having an anchorand a spring to hold the membrane in place, a centering rim on themembrane and a centering cable.

[0047]FIG. 12 is the same as FIG. 11 with the spring filling the atriumto help hold the membrane in place.

[0048]FIG. 13 is a partial cross sectional view of a portion of a heartshowing an atrium and its associated atrial appendage with the membraneadhesively being held in place.

[0049]FIG. 14 is a partial cross sectional view of a delivery catheterhaving a disk, a spring and membrane therein.

[0050]FIG. 15 is a schematic view of a disk, spring and membrane afterbeing expanded out of the delivery catheter of FIG. 11.

[0051]FIG. 16 is a partial cross sectional view of a portion of a heartshowing an atrium and its associated atrial appendage having a disk, amembrane and a spring therebetween.

[0052]FIG. 17 is a partial cross sectional view of a portion of a heartshowing an atrium and its associated atrial appendage shown in acollapsed position.

[0053]FIG. 18 is a partial cross sectional view of a portion of a heartshowing an atrium and its associated atrial appendage having a disk, aspring, a membrane and vacuum in the catheter.

[0054]FIG. 19 is a partial cross sectional view of a portion of a heartshowing an atrium and its associated atria appendage having a membranematerial fill the atrial appendage.

[0055]FIG. 20 is a partial cross sectional view of a portion of a heartshowing an atrium and its associated atrial appendage showing anumbrella folded for entering the atrial appendage.

[0056]FIG. 21 is a partial cross sectional view of a portion of a heartshowing an atrium and its associated atrial appendage showing theumbrella opened in the atrial appendage to secure the umbrella into thewall of the atrial appendage.

[0057]FIG. 22 is a partial cross sectional view of a portion of a heartshowing an atrium and its associated atrial appendage showing theumbrella and membrane sealing the ostium of the atrial appendage.

[0058]FIG. 23, is a partial cross sectional view of a portion of a heartshowing an atrium and its associated atrial appendage showing a stenthaving a membrane for blocking the ostium of the atrial appendage.

[0059]FIG. 24 is a partial cross sectional view of a portion of a heartshowing an atrium and its associated atrial appendage showing the atrialappendage reduced to a minimum volume by a disk and spring squeezing theappendage against a membrane.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0060] Although atrial fibrillation results in pooling of blood in theleft atrial appendage and the majority of use of the invention isanticipated to be for the left atrial appendage the invention may alsobe used on the right atrial appendage and in general for any aperture inthe body which needs to be blocked to prevent blood from flowingtherethrough or therefrom.

[0061] As shown in FIG. 4 a thrombus 30 may occur from pooling of bloodin the left atrial appendage 13 due to poor circulation of blood thereinwhen the patient experiences atrial fibrillation. To prevent thrombus 30from forming in the left atrial appendage 13 or to prevent thrombosisformed therein from leaving and entering the blood stream which maycause a heart attack, a stroke or ischemia, a membrane 40 is placedacross the ostium 20 of the atrial appendage 13. The membrane 40 can bemade of Teflon®, felt, Dacron®, silicone urethane, Gortex®, metal fibersor biocompatible polymers.

[0062] The membrane 40 may be a porous membrane. Porous membranes mayconsist of a biocompatible polymer which is porous, having pore sizesranging from 20-100 microns. The pores may also be larger or smaller inrare cases. The membrane may also be a porous metal or a metal mesh offine fibers which permit ingrowth of cells and covering with endothelialcells. The membrane may be coated with anticoagulant, or elute theanticoagulant.

[0063] The porous membrane colonizes with cells from the heart and sowalls off the ostium 20 so that blood can not flow into the left atrialappendage 13 to form thrombus 30 and more importantly no thrombus 30formed can leave the left atrial appendage 13 to cause heart attacks,strokes or ischemia.

[0064] The membrane 40 placed over the ostium 20 should beantithrombotic. In order to make the membrane antithrombotic heparin orother anticoagulants or antiplatelet agent may be used on the membrane40.

[0065] When porous membranes 40 are used which have an ingrowth of cellscovering the membrane with endothelial cells the endothelial cellspresent a smooth cellular wall covering the membrane which preventsthrombosis from occurring at the membrane.

[0066] When blood pools in the left atrial appendage 13, thrombus 30(blood clot) can accumulate therein, build upon themselves, andpropagate out from the left atrial appendage 13 into the left atrium 11entering the blood stream, leaving the heart and can block blood flow tothe heart, brain, other organs, or peripheral vessels if it becomeslodged in the arteries thereof.

[0067]FIGS. 1 and 2 show a cross section of a human heart showing athrombus 30 in the left atrial appendage 13. The figures also show theatrial appendage ostium 20 which is to have a membrane 40 placed over itto prevent the thrombus 30 from escaping out of the atrial appendage 13into the left atrium 11 and thus into the blood stream, which couldcause a stroke, a heart attack or ischemia The membrane 40 also preventsblood from entering the left atrial appendage 13 where it could pool dueto poor circulation and become a thrombus.

[0068]FIG. 3 shows a cross section of a human heart showing a thrombus30 in the right atrial appendage 23. The right atrial appendage 23, canbe treated in the same manner as the left atrial appendage 13.

[0069]FIG. 4 shows a cross section of the left atrium 11, the ostium 20and the left atrial appendage 13 having a thrombus 30 therein.

[0070]FIG. 5 shows a first embodiment of the invention wherein theporous membrane 40 has a plurality of flexible prongs 50 which may bemade from a shape memory alloy, such as Nitinol®, for retaining apredisposed shape. The prongs 50 may be atraumatic so that they do notperforate the left atrial appendage 13. The prongs 50 may haveatraumatic bulbs 55 on their tips so that the tips of the prongs 50 willnot perforate the left atrial appendage 13. Nitinol® has the property ofbeing able to be placed in a catheter in a compact configuration andthen expanded when released from the catheter to a predetermined memoryshape. The shape selected may be for the prongs 50 to curve around thelip of the ostium 20 and then hug the sides of the left atrial appendage13. In this manner the membrane 40 will securely block the ostium 20preventing blood from entering and particularly for preventingthrombosis 30 from leaving the left atrial appendage 13.

[0071] The membrane 40 is self centering over the ostium 20 of the leftatrial appendage 13, by placing the prongs 50 in a circle around themembrane 40 such that the prongs 50 fit against the wall of the leftatrial appendage 13 of or within the lumen of the ostium 20 to centerthe membrane 40 over the ostium 20. The membrane 40 may also be centeredby a centering rim 65 (see FIG. 6) attached to the back (appendage) sideof the membrane 40 that protrudes into the ostium 20 for centering Thecentering rim 65 has a diameter of less than the diameter of themembrane 40. The centering means may also consist of a series ofcentering cables 66 (see FIG. 11) which attach to a spring 90 or tether85 from the centering rim 65 or the membrane 40, to assure thatcentering occurs with placement.

[0072] Optionally electronics, such as sensors 300 and chips 310, builtinto the membrane may be used to provide data about hemodynamicspressure, flow rates, temperature, heart rates, and electrical signalsin the heart. When the membrane is placed in the left atrial appendage13 the sensors 300 may measure pressures in the atria or atrialappendage. The sensors may also measure ventricular end diastolicpressures through the open mitral or cuspid valves. Other informationabout the heart may be gathered such as noise from accelerometers todetect leakage, valve efficiency, activity levels of the patient andother noise related data. The sensors 300 may also be blood oxygensensors. The chip 310 may use telemetry to transmit the informationgathered by the sensors 300 and processed or stored by the chip 310 toreceiving devices to aid in the treatment of the patient.

[0073] In FIG. 6 the protective bulbs 55 are removed from the flexibleprongs 50 of FIG. 5 such that flexible prongs 50 puncture the walls ofthe left atrial appendage 13 and secure the membrane 40 in place Theflexible prongs 50 may penetrate into the atrial appendage wall orextend through the atrial appendage wall. The prongs may have barbedends 51 to prevent the prongs from withdrawing from the atrial appendagewall.

[0074] The membrane 40 has centering rim 65 attached for centering themembrane in the ostium 20 and marker 320 in the membrane 40 forobserving the position of the membrane while it is being inserted Themarker may be used for x-ray or ultrasound observation.

[0075] Although Nitinol® was cited above as a type of shape memory alloyprong material which can be used, any type memory alloy may be used.Such alloys tend to have a temperature induced phase change which willcause the material to have a preferred configuration when heated above acertain transition temperature. Other metals which may be used as prongsinclude corrosion resistant spring metals such as Elgiloy® or springtempered steel.

[0076] Another embodiment of the invention is shown in FIG. 7. It issimilar to the embodiment shown in FIG. 5. The embodiment in FIG. 7 hasa stent 60 attached to the membrane 40 for expanding in the ostium 20helping to secure the membrane 40 thereto. The prongs 50 operate in thesame manner as in FIG. 5 hugging the inner walls of the bit atrialmembrane 13 to secure the membrane 40 to cover the ostium 20. The stent60 may also be made from Nitinol®, Elgiloy® or another expandable springloaded or balloon expandable material.

[0077] The membrane 40 may be self centering over the ostium 20 of theleft 13 atrial appendage, by placing the stent 50 into the ostiumwherein the stent plugs the ostium with the membrane 40 centered in thestent. Further the prongs 50 fit against the wall of the left atrialappendage 13 of or within the lumen of the ostium 20 to center themembrane 40 over the ostium 20.

[0078] In FIG. 8 the protective bulbs 55 are removed from the flexibleprongs 50 of FIG. 7 such that flexible prongs 50 puncture the walls ofthe left atrial appendage 13 and secure the membrane 40 in place. Theflexible prongs 50 may penetrate into the atrial appendage wall orextend through the atrial appendage wall. The prongs may have barbedends 51 to prevent the prongs from withdrawing from the atrial appendagewall.

[0079] In the embodiment shown in FIG. 9 a larger expandable stent 70 isused to both engage the sides of the ostium 20 and hug the inside wallsof the left atrial membrane 13. Again the stent may be made of Nitinol®,Elgiloy® or other material which may be delivered in a catheter andexpanded to the proper size and shape to securely hold the membrane 40over the ostium 20 to prevent blood from entering the left atrialappendage 13 and for preventing thrombosis 30 from exiting.

[0080]FIG. 10 shows another embodiment of the invention wherein themembrane 40 is secured over the ostium 20 by means of an anchor 80 whichis driven into or through the wall of the left atrial appendage 13 andsecured therein by the surface area of the anchor so that it will notpull out of or through the wall of the left atrial appendage 13 or causeembolism from the left atrial appendage 13. A tether 85 is attached tothe anchor 80 and to the membrane 40 to secure the membrane 40 snugglyagainst the ostium 20. A substance 270 such as thrombin, activatedfibrinogen, or other biologic filler may be placed in the left atrialappendage 13 by injection through a catheter after the membrane 40 is inplace such that blood is clotted in the atrial appendage so that it cannot escape. The device delivery catheter itself may have a port for thisinjection. The port may also be used to inject contrast such as echocardiographic contrast that can be immediately visualized, and examinedto determine whether there is a good seal between the ostium of theappendage and the device. The substance 270 injected into the atrialappendage may also be a sealant or filler to seal the membrane againstleakage from the atrial appendage. The sealant material, filler materialor blood clotting material may be used with any of the embodiments ofthe invention.

[0081] In another embodiment the catheter may inject a chemical ablationagent such as ethanol to ablate the myocardial cells in the sealed offatrial appendage 13 and thus limit atrial fibrillation by limiting oreliminating electrical propagation in the atrial appendage.

[0082]FIG. 11 shows another embodiment of the invention wherein membrane40 has a spiral spring 90 in addition to the anchor 80. The spiralspring 90 can be used in conjunction with or separately from the tether85 to pull the membrane 40 against the ostium 20. Although a spiralspring 90 has been shown in FIG. 9 the shape used may be oval,cylindrical, oblong, or other shape to connect the anchor 80 to themembrane 40. In another embodiment shown in FIG. 12 the spiral spring 90may fill the volume of the left atrial appendage 13 securing themembrane 40 to the ostium 20. The spiral spring 90 filling the leftatrial appendage 13 may also have an anchor 80 and tether 85 to helpsecure the membrane 40 to the ostium 20. Alternatively centering rim 65may be used as shown in FIG. 11 to center the membrane 40 over ostium 20of left atrial appendage 13. Centering cables 66 connected to spring 90and either membrane 40 or centering rim 65 may also be used to centerthe membrane 40 over the ostium 20.

[0083]FIG. 13 shows yet another means of securing the membrane 40 overthe ostium 20. In this embodiment membrane 40 is directly attached tothe ostium 20 by an adhesive 100.

[0084]FIG. 14 shows a delivery catheter 125 containing a collapsedporous membrane 40 and a collapsed disk 130 connected to the porousmembrane 40 by a spring 90 on catheter 21. The disk 130 may be made of aflexible woven metal or a flexible woven metal with a thin porouspolymer sandwiched inside. Disk 130 may also be a polymer weave. Thedisk 130 is flexible and compresses or folds so it fits into thedelivery catheter 125 and expands to its desired shape after releasefrom the delivery catheter 125. Similarly membrane 40 compresses orfolds to fit into the delivery catheter 125 and expands to its desiredshape after release. FIG. 15 shows the porous membrane 40, disk 130 andspring 90 from FIG. 14 in an expanded configuration outside of thedelivery catheter 125.

[0085]FIG. 15 shows the spring 90 connecting the porous membrane 40 andthe disk 130 for urging them together. In other embodiments an elastictether or a tether with teeth and a pawl on the porous membrane 40 toform a ratchet can also be used to pull the porous membrane 40 and thedisk 130 together.

[0086]FIG. 16 shows the device of FIGS. 15 applied to the left atrialappendage 13 having thrombus 30. After the device is applied the spring90, pulls the disk 130 toward the porous membrane 40 collapsing the leftatrial appendage 13 and trapping the thrombus 30 therein as shown inFIG. 17.

[0087]FIG. 18 shows an alternate embodiment of the device in FIGS. 16and 17 wherein the catheter 21 is equipped with a vacuum 140 for suckingout blood and thrombosis 30 found in the left atrial appendage 13. Thevacuum 140 will help collapse the left atrial appendage 13 such thatspring 90 need not be as large as in FIG. 16.

[0088]FIG. 19 shows an alternative embodiment of the device where themembrane 150 is inserted into the left atrial appendage 13 and fills itsecuring the membrane 150 therein. The membrane 150 may be delivered ina catheter as a compressed material and expanded in the atrial appendage13 or be delivered in a liquid form which will fill the atrial appendageand be transformed into a membrane by curing with another chemicaldelivered by the catheter or with the aid of a UV light supplied througha fiber optic cable in the catheter 21. By filling the left atrialappendage 13 with a membrane material 150 no blood can enter to pool andbecome a thrombus 30 and no thrombus 30 can exit to cause heart attacks,strokes and ischemia.

[0089] FIGS. 20-22 show another embodiment of the invention using anumbrella principle for securing the membrane 40 against the ostium 20.FIG. 17 shows closed umbrella struts 160 entering the ostium 20 of leftatrial appendage 13. The membrane 40 is some distance back from theumbrella struts 160 at the bottom of the range of teeth 195 on pole 170.FIG. 21 shows the umbrella struts inside of the left atrial appendage 13with the struts 160 open. Umbrella opening structure 175 on pole 170pushes the struts out to the umbrella open position. The umbrellaopening structure 175 can be pushed to the open position or have aspring loaded mechanism to push the struts 160 to the open position. Theends of the umbrella struts 160 engage the left atrial appendage wallaround the ostium 20 and prevent the umbrella from being withdrawn fromthe left atrial appendage 13. The ends of the umbrella struts 160 thatengage the atrial appendage wall may be blunted or have bulbs on thetips or have padding so as not to puncture the left atrial appendage 13.FIG. 22 shows the membrane 40 drawn up against the ostium 20 byratcheting the membrane along pole 170. The pawl mechanism 200 engagesteeth 195 on pole 170 and is moved forward to snuggly block the ostium20 with the membrane 40.

[0090]FIG. 23 shows a stent 260 applied to the ostium 20 of left atrialappendage 13. The stent 260 expands after leaving a delivery cathetersuch that the wall of the stent secures the stent by pressure to theostium 20. Membrane 240 folds or is compressed into the deliverycatheter and expands as the stent 260 expands and lodges in the ostium20 of the left atrial appendage 13.

[0091]FIG. 24 shows the left atrial appendage 13 compressed such thatthe volume of the atrial appendage is reduced to almost nothing. Withthe volume reduced the atrial appendage will not have a large volume ofblood which can produce a thrombus. In the embodiment shown disk 130 andspring 90 pull the left atrial appendage 13 toward membrane 40. AlthoughFIG. 24 shows the use of a disk 130 and spring 90 to act on the leftappendage any method to reduce the volume of the atrial appendage asmuch as possible may be used. In addition to physically reducing thevolume a substance 270 may be injected into the appendage to ether limitits volume, or to clot the blood already present therein.

[0092] As shown in FIG. 24 the membrane 40 is much larger than theostium 20. The over size membrane 40 may be used in all embodiments toensure that the ostium 20 is completely blocked.

[0093] The devices described above may be percutaneously delivered tothe left and right atrial appendages 13, 23 respectively. The devicesmay have materials in them which enhance visualization or imaging byultrasound, x-ray or other means making it easier or the device to beimplanted and accurately centered over the ostium 20 of the atrialappendage 13. This may consist of small beads placed strategically onthe membrane, the connecting elements, or on the anchors. Referring toFIG. 1 catheter 21 is seen entering the heart by way of the aorta 12 tothe left ventricle 16 passing through the mitral valve 17 and thenentering the left atrial appendage 13 to apply the porous membrane 40 inone of the embodiments as disclosed above. In FIG. 2 the catheter 21enters the heart from the femoral vein, passes through the inferior venacava 18 to the right atrium and then passes through the fossa ovalis 19or through the septum 29 into the left atrium 11 and then approaches theleft atrial appendage 13 to apply the porous membrane 40 thereto. FIG. 3shows the catheter 21 being applied to the right atrial appendage 23.Catheter 21 may enter the heart through the jugular vein 28 or thefemoral vein to the inferior vena cava 18.

[0094] It should be understood that the invention may be practiced withnumerous means of attaching the membrane 40 to cover the ostium 20 ofthe atrial appendages 13 and 23. Any combination of the attachment meanswith adhesives, prongs, stents, anchors, disks, tethers or springs maybe used. The membrane may also be inside of the atrial appendages 13 and23, or may penetrate the atrial appendage and provide a means tosecurely lock the membrane device into place. Other means of providing amembrane for blocking blood flow into and blood clots out of the atrialappendages not listed may also be used. A substance may be injected intothe appendage to limit its volume, or to clot the blood aleady present.

[0095] In all of the above embodiments the blood of the appendage may befacilitated to clot in order to from a large, immobile mass.Alternatively, the appendage may be filled with any substance that willoccupy volume. Examples are fibrin, prosthetic polymers (PLLA),Silicone, or a balloon that is delivered and remains in place for longperiods of time.

[0096] All of the above embodiments shown and discussed for the leftatrial appendage 13 are also useable on the right atrial appendage 23.Further the invention may be used to close fistulae or connectionselsewhere in the body such as the colon or bronchopulmonary systems. Theinvention may also be used to seal false aneurysms. When the membrane isplaced in a false aneurysm it will strengthen the defect and may help toavoid surgery.

[0097] Obviously, many modifications and variations of the presentinvention are possible in light of the above teachings. It is thereforeto be understood that, within the scope of the appended claims, theinvention may be practiced otherwise than as specifically described.

What is claimed is:
 1. A method of preventing atrial appendage thrombusfrom entering the blood stream comprising: blocking an atrial appendageostium with a membrane preventing blood from entering the atrialappendage and forming thrombus therein and preventing thrombosis formedtherein from leaving.
 2. A method of preventing atrial appendagethrombus from entering the blood stream as in claim 1 furthercomprising: securing the membrane over the ostium of the atrialappendage by extending prongs from the membrane into the atrialappendage through the ostium.
 3. A method of preventing atrial appendagethrombus from entering the blood stream as in claim 2 furthercomprising: piercing the wall of the atrial appendage with the prongsextending into the atrial appendage wall to secure the membrane inplace.
 4. A method of preventing atrial appendage thrombus from enteringthe blood stream as in claim 2 further comprising: attaching bulbs onthe ends of the prongs to prevent puncturing the interior of the atrialappendages from causing emboli.
 5. A method of preventing atrialappendage thrombus from entering the blood stream as in claim 2 flirtercomprising: centering the membrane over the ostium by prongs attached tothe membrane in a circle such that the prongs will position the membraneover the ostium without leaving gaps between the ostium and themembrane.
 6. A method of preventing atrial appendage thrombus fromentering the blood stream as in claim 2 further comprising: extending astent between the membrane and the prongs to engage the ostium of theatrial appendage for securing the membrane to the ostium.
 7. A method ofpreventing atrial appendage thrombus from entering the blood stream asin claim 6 further comprising: piercing the wall of the atrial appendagewith the prongs extending into the atrial appendage wall to secure themembrane in place.
 8. A method of preventing atrial appendage thrombusfrom entering the blood stream as in claim 1 further comprising:securing the membrane over the ostium of the atrial appendage byextending stent legs into the atrial appendage through the ostium of theatrial appendage to hold the membrane snuggly against the ostium of theatrial appendage.
 9. A method of preventing atrial appendage thrombusfrom entering the blood stream as in claim further comprising: securingthe membrane over the ostium of the atrial appendage by extending ananchor into or through the wall of the atrial appendage and attaching atether between the atrial appendage and the membrane for holding themembrane snuggly against the ostium of the atrial appendage.
 10. Amethod of preventing atrial appendage thrombus from entering the bloodstream as in claim 9 further comprising: providing an elastic tether forsealing the membrane over the ostium of the atrial appendage.
 11. Amethod of preventing atrial appendage thrombus from entering the bloodstream as in claim 1 further comprising: securing the membrane over theostium of the atrial appendage by inserting an anchor in the wall of theatrial appendage and attaching a spring between the anchor and theatrial appendage to urge the membrane against the ostium of the trialappendage.
 12. A method of preventing atrial appendage thrombus fromentering the blood stream as in claim 1 further comprising: providing aspiral spring connected to the membrane, for a snug filling of theatrial appendage, and sealing the membrane over the ostium of the atrialappendage.
 13. A method of preventing atrial appendage thrombus fromentering the blood stream as in claim 1 further comprising: securing themembrane over the ostium of the atrial appendage adhesively.
 14. Amethod of preventing atrial appendage thrombus from entering the bloodstream as in claim 1 further comprising: securing the membrane over theostium of the atrial appendage by extending a disk through the wall ofthe atrial appendage and attaching a tether between the atrial appendageand the membrane for holding the membrane snuggly against the ostium ofthe atrial appendage.
 15. A method of preventing atrial appendagethrombus from entering the blood stream as in claim 14 furthercomprising: employing an elastic tether for urging the membrane snugglyagainst the ostium of the atrial appendage.
 16. A method of preventingatrial appendage thrombus from entering the blood stream as in claim 1further comprising: attaching the membrane to the ostium of the atrialappendage by extending a disk through the wall of the atrial appendageand attaching a spring between the atrial appendage and the membrane forurging the membrane snuggly against the ostium of the atrial appendage.17. A method of preventing atrial appendage thrombus from entering theblood stream as in claim 1 further comprising: vacuuming the atrialappendage for removing thrombus from therein and for collapsing theatrial membrane.
 18. A method of preventing atrial appendage thrombusfrom entering the blood stream as in claim 1 further comprising:blocking the atrial appendage ostium by filling the atrial appendagewith a membrane material.
 19. A method of preventing atrial appendagethrombus from entering the blood stream as in claim 1 furthercomprising: securing the membrane over the ostium of the atrialappendage by extending a plurality of umbrella struts on an umbrellapole into the atrial appendage while the umbrella struts are in a closedposition and opening the umbrella struts in the atrial appendage suchthat the umbrella struts engage the atrium appendage wall and can not bewithdrawn through the ostium then moving the membrane on the umbrellapole to secure it in position on the opposing-side of the ostium holdingthe ostium wall between the membrane and the umbrella struts thussecuring the membrane over the ostium of the atrial appendage.
 20. Amethod of preventing atrial appendage thrombus from entering the bloodstream as in claim 1 further comprising: attaching the membrane to theostium of the atrial appendage by extending a collapsible stent into theostium such that the stent expands and engages the circumference of theostium and attaching a collapsible membrane across the lumen of thestent such that opening the stent stretches the membrane across thelumen of the stent thus blocking the ostium.
 21. A method of preventingatrial appendage thrombus from entering the blood stream as in claim 1further comprising: coating the membrane with an anticoagulant drug toprevent thrombosis.
 22. A method of preventing atrial appendage thrombusfrom entering the blood stream as in claim 1 further comprising:providing a porous membrane for encouraging endothelial cells to grow inthe membrane thus providing a cell wall over the membrane to preventthrombosis.
 23. A method of preventing atrial appendage thrombus fromentering the blood stream as in claim 1 further comprising: injecting asealant material into the atrial appendage to seal the membrane againstthe ostium to prevent leakage.
 24. A method of preventing atrialappendage thrombus from entering the blood stream as in claim 1 furthercomprising: injecting a filler material into the atrial appendage toreduce the volume of the atrial appendage.
 25. A method of preventingatrial appendage thrombus from entering the blood stream as in claim 1further comprising: injecting a blood coagulating substance into theatrial appendage to clot the blood therein and prevent it from flowingout of the atrial appendage.
 26. A method of preventing atrial appendagethrombus from entering the blood stream as in claim 1 furthercomprising: injecting an ablative chemical into the atrial appendage toablate myocardial tissue thus preventing electrical propagation ofatrial fibrillation.
 27. A method for preventing atrial appendagethrombus from entering the blood stream as in claim 1 furthercomprising: providing a means for centering the membrane over the ostiumof the atrial appendage to provide a good seal.
 28. A method forpreventing atrial appendage thrombus from entering the blood stream asin claim 27 wherein the means for centering the membrane over the ostiumcomprises: attaching a centering rim to the membrane for insertion intothe ostium of the atrial appendage.
 29. A method for preventing atrialappendage thrombus from entering the blood stream as in claim 27 whereinthe means for centering the membrane over the ostium comprises:attaching a centering rim to the membrane for insertion into the ostiumof the atrial appendage, attaching a securing means to the wall of theatrial appendage and connecting the securing means a spring between thesecuring means and the membrane to urge the membrane against the ostiumof the atrial appendage, attaching a plurality of cables from the springto the membrane to center the membrane over the ostium of the atrialappendage.
 30. A method for preventing atrial appendage thrombus fromentering the blood stream as in claim 27 wherein the means for centeringthe membrane over the ostium comprises: attaching a centering rim to themembrane for insertion into the ostium of the atrial appendage,attaching a securing means to the wall of the axial appendage andconnecting the securing means a spring between the securing means andthe membrane to urge the membrane against the ostium of the atrialappendage, attaching a plurality of cables from the spring to thecentering rim of the membrane to center the membrane over the ostium ofthe atrial appendage.
 31. A method for preventing atrial appendagethrombus from entering the blood steam as in claim 27 wherein the meansfor centering the membrane over the ostium comprises: attaching asecuring means to the wall of the atrial appendage and connecting thesecuring means a spring between the securing means and the membrane tourge the membrane against the ostium of the atrial appendage, attachinga plurality of cables from the spring to the membrane to center the amembrane over the ostium of the atrial appendage.
 32. A method forpreventing atrial appendage thrombus from entering the blood stream asin claim 27 wherein the means for centering the membrane over the ostiumcomprises: attaching a centering rim to the membrane for insertion intothe ostium of the atrial appendage, attaching a securing means to thewall of the atrial appendage and connecting the securing means a tetherbetween the securing means and the membrane to urge the membrane againstthe ostium of the atrial appendage, attaching a plurality of cables fromthe tether to the centering rim of the membrane to center the membraneover the ostium of the atrial appendage.
 33. A method for preventingatrial appendage thrombus from entering the blood stream as in claim 27wherein the means for centering the membrane over the ostium comprises:attaching a securing means to the wall of the atrial appendage andconnecting the securing means a tether between the securing means andthe membrane to urge the membrane against the ostium of the atrialappendage, attaching a plurality of cables from the tether to themembrane to center the membrane over the ostium of the atrial appendage.34. A method for preventing atrial appendage thrombus from entering theblood stream as in claim 27 wherein the means for centering the membraneover the ostium comprises: attaching a centering rim to the membrane forinsertion into the ostium of the atrial appendage, attaching a securingmeans to the wall of the atrial appendage and connecting the securingmeans a tether between the securing means and the membrane to urge themembrane against the ostium of the atrial appendage, attaching aplurality of cables from the tether to the membrane to center themembrane over the ostium of the atrial appendage.
 35. A method forpreventing atrial appendage thrombus from entering the blood steam as inclaim 1 further comprising: attaching markers to the membrane forobserving the position of the membrane as it is placed in the ostium ofthe atrial appendage.
 36. A method for preventing atrial appendagethrombus from entering the blood stream as in claim 1 furthercomprising: attaching sensors to the membrane for providing informationabout the patient.
 37. A membrane for blocking an atrial appendageostium comprising: a membrane, a means for blocking the ostium of theatrial appendage with the membrane such that no blood enters the atrialappendage to from a thrombus and no thrombus escapes the atrialappendage.
 38. A membrane for blocking the ostium of an atrial appendageostium as in claim 37 wherein: the means for blocking the atrialappendage comprises a membrane over the ostium, the membrane having aplurality of prongs extending through the ostium and hugging the wallsof the atrial appendage such that the membrane is held firmly over theostium.
 39. A membrane for blocking an atrial appendage ostium as inclaim 38 wherein: memory alloy prongs are used to expand to the desiredshape inside of the atrial appendage to firmly hold the membrane overthe ostium.
 40. A membrane for blocking an atrial appendage ostium as inclaim 37 wherein: a bulb on the tip of each of the prongs preventsembolisms caused by the prongs impaling the atrial appendage walls. 41.A membrane for blocking an atrial appendage ostium as in claim 37wherein: the prongs pierce the atrial appendage wall to secure themembrane in place.
 42. A membrane for blocking an atrial appendageostium as in claim 37 wherein: the prongs are attached to the membranein a circle such that the prongs will center the membrane over theostium.
 43. A membrane for blocking an atrial appendage ostium as inclaim 37 wherein: a stent between the membrane and the prongs engagesthe diameter of the ostium of the atrial appendage and holds themembrane securely in place over the ostium.
 44. A membrane for blockingan atrial appendage ostium as in claim 43 wherein: the prongs pierce theatrial appendage wall to secure the membrane in place.
 45. A membranefor blocking an atrial appendage ostium as in claim 37 wherein: themeans for blocking the ostium comprises, a plurality of stent legsattached to the membrane and extending inside of the atrial appendagethrough the ostium of the atrial appendage.
 46. A membrane for blockingan atrial appendage ostium as in claim 45 wherein: memory alloy stentlegs are used to expand to the desired shape inside of the atrialappendage to firmly hold the membrane over the ostium.
 47. A membranefor blocking an atrial appendage ostium as in claim 37 wherein: themeans for blocking the ostium comprises, an anchor into or through thewall of the atrial appendage and a tether connecting the anchor and themembrane to securely hd the membrane over the ostium of the atrialappendage.
 48. A membrane for blocking an atrial appendage ostium as inclaim 47 wherein: the tether is elastic for securely drawing themembrane against the ostium of the atria appendage.
 49. A membrane forblocking an atrial appendage ostium as in claim 37 wherein: the meansfor blocking the ostium comprises, an anchor into or through the wall ofthe atrial appendage and a spring connecting the anchor and the membraneto securely hold the membrane over the ostium of the atrial appendage.50. A membrane for blocking an atrial appendage ostium as in claim 37wherein: the means for blocking the ostium comprises a spiral springfilling the atrial appendage and connected the membrane to securely holdthe membrane over the ostium of the atrial appendage.
 51. A membrane forblocking an atrial appendage ostium as in claim 37 wherein: the meansfor blocking the ostium comprises an adhesive on the membrane forsecuring the membrane over the ostium of the atrial membrane.
 52. Amembrane for blocking an atrial appendage ostium as in claim 37 wherein:a vacuum removes thrombus from the atrial appendage and reduces thevolume of the atrial appendage by suction.
 53. A membrane for blockingan atrial appendage ostium as in claim 37 wherein: the means forblocking the ostium comprises, an disk on the opposite side of the wallof the atrial appendage and a spring connecting the disk and themembrane to securely hold the membrane over the ostium of the atrialappendage.
 54. A membrane for blocking an atrial appendage ostium as inclaim 37 wherein: the means for blocking the ostium comprises, an diskon the opposite side of the wall of the atrial appendage and a tetherconnecting the disk and the membrane to securely hold the membrane overthe ostium of the atrial appendage.
 55. A membrane for blocking anatrial appendage ostium as in claim 37 wherein: the means for blockingthe ostium comprises a membrane material filling the atrial appendage.56. A membrane for blocking an atrial appendage ostium as in claim 37wherein: the means for blocking the ostium comprises a pole having aplurality of umbrella struts at one end, an umbrella strut openingmechanism for extending the umbrella struts from a closed position withthe umbrella struts adjacent the pole to an open position with theumbrella struts extending radially away from the pole, such that theumbrella struts may be inserted through the ostium of an atrialappendage in the closed position and then opened such that the umbrellastruts engage the atrial appendage wall and can not be removed from theostium, the pole having a plurality of teeth, a pawl in the membrane forforming a ratchet in combination with the teeth to move the membranealong a length of the pole into a locked position securing it againstthe ostium of the atrial appendage opposite the umbrella struts.
 57. Amembrane for blocking an atrial appendage ostium as in claim 37 wherein:the means for blocking the ostium a collapsible stent for insertion intothe ostium such that the stent expands and engages the circumference ofthe ostium and attaching a collapsible membrane across the lumen of thestent such that opening the stent stretches the membrane across thelumen of the stent thus blocking the ostium.
 58. A membrane for blockingan atrial appendage ostium as in claim 37 wherein: an anticoagulant drugon the membrane to prevent thrombosis.
 59. A membrane for blocking anatrial appendage ostium as in claim 37 wherein: an ablative chemicalinjected into the atrial appendage ablates myocardial tissue thuspreventing electrical propagation of atrial fibrillation.
 60. A membranefor blocking an atrial appendage ostium as in claim 37 wherein: themembrane is a porous membrane to encourage endothelial cells to grow inthe pores of the membrane thus providing a cell wall over the membraneto prevent thrombosis.
 61. A membrane for blocking an atrial appendageostium as in claim 37 wherein: the membrane is a metal mesh to encourageendothelial cells to grow in the pores of the membrane thus providing acell wall over the membrane to prevent thrombosis.
 62. A membrane forblocking an atrial appendage ostium as in claim 37 wherein: a substancein the atrial appendage seals the membrane against leakage.
 63. Amembrane for blocking an atrial appendage ostium as in claim 37 wherein:a substance in the atrial appendage fills the atrial appendage andreducing its volume.
 64. A membrane for blocking an atrial appendageostium as in claim 37 wherein: a coagulant in the atrial appendagecoagulates the blood therein such that it can not escape the atrialappendage.
 65. A membrane for blocking an atrial appendage ostium as inclaim 37 wherein: the membrane has a means for centering the membraneover the ostium of the trial appendage.
 66. A membrane for blocking anatrial appendage ostium as in claim 65 wherein the means for centeringthe membrane over the ostium comprises: a centering rim on the membranefor placement in the ostium.
 67. A membrane for blocking an atrialappendage ostium as in claim 65 wherein the means for centering themembrane over the ostium comprises: a means for securing a spring to awall of the atrial appendage and securing the other end of the spring tothe membrane, a plurality of cables on the spring connected to themembrane for centering the membrane over the ostium.
 68. A membrane forblocking an atrial appendage ostium as in claim 65 wherein: a centeringrim on the membrane for placement in the ostium, a means of securing aspring to a wall of the atrial appendage and securing the other end ofthe spring to the membrane, a plurality of cables on the springconnected to the membrane for centering the membrane over the ostium.69. A membrane for blocking an, atrial appendage ostium as in claim 65wherein: a centering rim on the membrane for placement in the ostium, ameans of securing a spring to a wall of the atrial appendage andsecuring the other end of the spring to the membrane, a plurality ofcables on the spring connected to the centering rim on the membrane forcentering the membrane over the ostium.
 70. A membrane for blocking anatrial appendage ostium as in claim 65 wherein the means for centeringthe membrane over the ostium comprises: a means for securing a tether toa wall of the atrial appendage and securing the other end of the tetherto the membrane, a plurality of cables on the tether connected to themembrane for centering the membrane over the ostium.
 71. A membrane forblocking an atrial appendage ostium as in claim 65 wherein: a centeringrim on the membrane for placement in the ostium, a means of securing atether to a wall of the atrial appendage and securing the other end ofthe tether to the membrane, a plurality of cables on the tetherconnected to the membrane for centering the membrane over the ostium.72. A membrane for blocking an atrial appendage ostium as in claim 65wherein: a centering rim on the membrane for placement in the ostium,means of securing a tether to a wall of the atrial appendage andsecuring the other end of the tether to the membrane, a plurality ofcables on the tether connected to the centering rim on the membrane forcentering the membrane over the ostium.
 73. A membrane for blocking anatrial appendage ostium as in claim 65 wherein the means for centeringthe membrane over the ostium comprises: makers attached to the membranefor observing the position of the membrane as it is placed in the ostiumof the atrial appendage.
 74. A membrane for blocking an atrial appendageostium as in claim 37 wherein, at least one sensor attached to themembrane for monitoring a patient.
 75. A method of obstructing openingsin the body of a patient comprising: non invasively inserting membranesin the openings by use of catheters to block the opening, securing themembrane in place by the membrane lodging against the opening andproviding a means for attaching the membrane to body tissue on theopposite side of the opening.
 76. A method of obstructing openings inthe body of a patient as in claim 75 further comprising: securing themembrane over a false aneurysm.
 77. A method of obstructing openings inthe body of a patient as in claim 75 further comprising: securing themembrane over a fistulae.
 78. A method of obstructing openings in thebody of a patient as in claim 75 further comprising: securing themembrane over an ostium of an atrial appendage.
 79. A membrane forobstructing openings in the body of a patient comprising: a membrane, ameans for securing the membrane over the opening by placing the membraneon one side of the opening and a means for securing a connecting elementto body tissue on the opposite side of the opening from the membrane.80. A membrane for obstructing openings in the body of a patient as inclaim 79 wherein: a false aneurysm is covered by the membrane.
 81. Amembrane for obstructing openings in the body of a patient as in claim79 wherein: a fistulae is covered by the membrane.
 82. A membrane forobstructing openings in the body of a patient as in claim 79 wherein anostium of an atrial appendage is covered by the membrane.